Apprehension and Relocation

Apprehension and Relocation test is used to test for anterior instability of the shoulder joint.
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 Apprehension and Relocation

What is Apprehension and Relocation?

  • Apprehension and Relocation test is used to test for anterior instability of the shoulder joint.

How it's Performed?

The examination begins with the patient seated:

  • The examiner palpates the humeral head through the surrounding soft tissue with one hand and guides the patient’s arm with the other hand.
  • The examiner passively abducts the patient’s shoulder with the elbow flexed and then brings the shoulder into maximum external rotation, keeping the arm in this position.
  • The test is performed at 60°, 90°, and 120° of abduction to evaluate the superior, medial, and inferior glenohumeral ligaments.
  • With the guiding hand, the examiner presses the humeral head in an anterior and inferior direction.

The Apprehension and Relocation test can also be performed in the supine position with improved muscular relaxation:

  • The shoulder lies on the edge of the examining table, which acts as a fulcrum.
  • In this position the apprehension test can be initiated in various external-rotation and abduction positions.
  • The healthy shoulder serves for comparison.

What does a positive Apprehension and Relocation mean?

Anterior shoulder pain with reflexive muscle tensing is a sign of an anterior instability syndrome.

  • The patient has apprehension, the fear that the shoulder will dislocate. Prompted by pain, he or she tries to avoid the examiner’s movement.
  • Even without pain, however, the tension of the anterior shoulder musculature (pectoralis) alone may be a sign of instability.
  • Placing the patient supine improves the specificity of the apprehension test.

Jobe Relocation test:

  • From the apprehension position, the examiner applies a posterior translational stress to the head of the humerus, thereby leading to a sudden decrease in pain and of the fear of dislocation (the humeral head reduces into the socket, and external rotation can be increased).
  • In a further stage of the apprehension and relocation test, releasing the posteriorly directed pressure causes a sudden increase in pain with the apprehension phenomenon (release test).

Sensitivity & Specificity

  • Sensitivity: 68-88 %
  • Specificity: 50-100 %

Notes

  • When the patient complains of sudden stabbing pain with simultaneous or subsequent paralyzing weakness in the affected extremity, this is referred to as the “dead arm sign.”
  • It is attributable to the transient compression the subluxated humeral head exerts on the plexus.
  • It is important to know that at 45° of abduction the test primarily evaluates the medial glenohumeral ligament and the subscapularis tendon.
  • At or above 90° of abduction, the stabilizing effect of the subscapularis is neutralized and
    the test primarily evaluates the inferior glenohumeral ligament.
  • The Apprehension and Relocation test must be performed slowly and carefully to avoid the danger of causing the humeral head to dislocate.

Reference

Anterior apprehension test
Anterior apprehension test Anterior apprehension relocation test Anterior apprehension relocation test
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